CPT code 11643 is for the excision of malignant skin lesions on the face, ears, eyelids, nose, or lips, measuring 2.1 to 3 cm, including margins.
CPT code 11643 is used to describe the excision of malignant skin lesions, including margins, on the face, ears, eyelids, nose, or lips, with the lesion size ranging from 2.1 to 3.0 centimeters. This code is specifically utilized by healthcare providers to document and bill for the surgical removal of cancerous skin growths in these sensitive areas, ensuring that the procedure is accurately recorded for reimbursement and medical records.
When using CPT code 11643, which pertains to the excision of malignant skin lesions on the face, ears, eyelids, nose, or lips with margins of 2.1 to 3.0 cm, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Applied when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body.
4. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session.
5. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if the procedure is planned or staged, or if it is more extensive than the original procedure.
6. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Applied when the same procedure is repeated by the same physician.
8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used when the same procedure is repeated by a different physician.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Applied if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required for the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
15. Modifier LT (Left Side): Applied when the procedure is performed on the left side of the body.
16. Modifier RT (Right Side): Used when the procedure is performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11643 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of payment rates for services covered by Medicare, including CPT code 11643. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have specific guidelines and rates for different localities. Therefore, it is advisable to consult the MPFS and the relevant MAC for the most accurate and up-to-date reimbursement information for CPT code 11643.
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